I can thoroughly identify with the issues raised by Clare Allan (Form of torment, March 28). I was the director of what was probably one of the first UK NHS trust nationwide patient satisfaction surveys while a researcher in the late 1990s. My experiences of that work, and ever since, in my many contacts with the health service as both a professional researcher and patient is that there is a deep-seated reluctance to really engage patients in the definition of what it means to be a satisfied user of NHS services.

NHS practitioners resist inclusion of questions that patients have clearly stated are key issues. Some resist inclusion of survey items that allow patients to define what is important to them. NHS managers resist analyses of responses that show patients are really unhappy about the things that really matter to them, such as the personal behaviour of medical practitioners, and prefer to focus on issues such as car parking and toilet cleanliness which, though also not well received by patients, are not the issues that patients persistently define as important. The root of all this is a failure to properly empower patients in this enterprise. Paul Kiffresearch skills training leader, University of East London Graduate School

· Thanks to Clare Allan for writing about the relevance, incomprehensibility and motivations behind NHS "quality" assurance. I am a clinical psychologist working in the NHS and have watched with interest the rise of the quality agenda. I too am sceptical - it seems to me to be a managerial tool of control with which to usurp the power of health professionals under the unchallengeable guise of the patient rights agenda.

The whole thing is easy to stage: managers target a group of disgruntled mental health patients - of which there are many, unsurprisingly - and give them a carefully crafted questionnaire about the service they get. They report dissatisfaction, and this feedback is used to criticise and disempower the professionals. There can be no excuse for not listening carefully and treating patients with respect and dignity. But respondents have little understanding that the clinicians are in many instances the end point of a huge and largely hidden machinery, have little real influence upon it, and themselves are trying as best they can to cope within it. Andrew Ganleyvia email

· The NHS, already grossly overloaded with bureaucracy, now further burdens mental health nurses by getting them to read out long, pointless tick-box questionnaires to their clients about how satisfied they are with the services they receive. It is not surprising that only about one in 15 users fill them in when they receive them by post. Providers do need to know what their clients think of them so services can improve. But this is not the way to go about it.

The conversational approach that forms part of qualitative research methodology is more likely to engage both satisfied and dissatisfied clients, and result in useful information being obtained. Twenty-five thoughtfully carried out interviews will produce more valuable data than thousands of responses to a mindless questionnaire. Philip Grahamvia email

Hit and miss

Your fascinating supplement (Gender equality, March 28) covered some key areas that will be affected by the gender equality duty, but glaringly omitted any mention of ending violence against women.

With one in two women in England and Wales experiencing domestic violence, sexual assault or stalking, violence against women is a persistent inequality affecting women's health and undermining their ability to participate fully in society as equal citizens.

What we need from the Commission for Equality and Human Rights is fresh thinking about the way we address violence against women, shifting the current approach of mopping up to one of preventing violence happening in the first place. Professor Liz Kellychair, End Violence Against Women

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